Downloaded by [New York University] at 02:09 15 August 2016 Alzheimer’S Disease and Other Dementias

Downloaded by [New York University] at 02:09 15 August 2016 Alzheimer’s Disease and Other Dementias Working with the needs of patients with Alzheimer’s disease can be a major challenge for primary care physicians, psychiatrists, and other mental health professionals. Alzheimer’s wreaks havoc on the patient, and its degenerative nature can create a protracted period of anguish and anxiety for the patient’s family. Dr. Marc Agronin has put his years of experience as a geriatric psychiatrist to work to create an eminently useful resource for psychiatrists and others who treat patients suffering from Alzheimer’s disease or other dementias. Now in its third edition, Alzheimer’s Disease and Other Dementias uses con- cise and clear language to outline the symptoms, effects, and treatments used to combat the progress of Alzheimer’s disease and other dementias likely to be suffered by older patients. Enriched by case studies from his own clinical practice, Dr. Agronin creates a volume full of humanity, insight, and knowledge that is sure to inform and improve the habits and methods of any clinician who deals with Alzheimer’s disease and other forms of dementia. Marc E. Agronin , MD, is a board-certified adult and geriatric psychiatrist; he serves as the medical director for mental health and clinical research at the Miami Jewish Health Systems and as an affiliate associate professor of psychiatry and neurology at the University of Miami Miller School of Medicine. He is the author of numerous articles and books in the field of psychiatry and a nationally known speaker and expert on Alzheimer’s disease and other late-life psychiatric disorders. In 2008, Dr. Agronin was named “clinician of the year” by the American Association for Geriatric Psychiatry. He is the author of How We Age: A Doctor’s Journey into the Heart of Growing Old and Therapy with Older Clients: Key Strategies for Success , as well as coeditor of Principles and Practice of Geriatric Downloaded by [New York University] at 02:09 15 August 2016 Psychiatry, second edition. This page intentionally left blank Downloaded by [New York University] at 02:09 15 August 2016 Alzheimer’s Disease and Other Dementias A Practical Guide Third Edition Marc E. Agronin Downloaded by [New York University] at 02:09 15 August 2016 Third edition published 2014 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 27 Church Road, Hove, East Sussex BN3 2FA Routledge is an imprint of the Taylor & Francis Group, an informa business © 2014 Marc E. Agronin The right of Marc E. Agronin to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. First edition published by Lippincott Williams & Wilkins 2004 Second edition published by Lippincott Williams & Wilkins 2007 Library of Congress Cataloging-in-Publication Data Agronin, Marc E. Alzheimer’s disease and other dementias : a practical guide / by Marc E. Agronin. — 3rd edition. pages cm Includes bibliographical references and index. 1. Dementia—Handbooks, manuals, etc. 2. Dementia—Patients—Care— Handbooks, manuals, etc. 3. Caregivers—Handbooks, manuals, etc. 4. Geriatric psychiatry—Handbooks, manuals, etc. I. Title. RC521.A377 2014 616.8′3—dc23 2013037410 ISBN: 978-0-415-85699-7 (hbk) ISBN: 978-0-415-85700-0 (pbk) ISBN: 978-0-203-70836-1 (ebk) Typeset in Minion by Apex CoVantage, LLC Downloaded by [New York University] at 02:09 15 August 2016 To the past . The blessed memory of my grandparents, Dr. Simon and Eva Cherkasky and Tany and Etta Agronin; To the present . The love and support of my wife, Robin; To the future . My sons, Jacob, Max, and Samuel Downloaded by [New York University] at 02:09 15 August 2016 This page intentionally left blank Downloaded by [New York University] at 02:09 15 August 2016 Contents Foreword ix peter v. rabins Acknowledgments xi Introduction to the Third Edition xiii PART I Clinical Assessment of Dementia 1 1 An Overview of Dementia 3 2 The Dementia Workup 13 PART II Dementia Subtypes 39 3 Mild Cognitive Impairment 41 4 Alzheimer’s Disease 48 5 Vascular Dementia 83 Downloaded by [New York University] at 02:09 15 August 2016 6 Dementia with Lewy Bodies 96 7 Frontotemporal Dementia 105 8 Dementia Associated with Medical Conditions 119 viii Contents PART III Psychiatric Conditions Associated with Dementia 151 9 Agitation and Psychosis 153 10 Depression, Anxiety, and Apathy 183 PART IV Psychosocial Issues in Dementia Care 203 11 Legal and Ethical Issues 205 12 Caring for the Caregiver 217 Index 235 Downloaded by [New York University] at 02:09 15 August 2016 Foreword Physicians often ask themselves, Why should I be interested in brain diseases such as dementias? In this third edition of Alzheimer’s Disease and Other Dementias, A Practical Guide , Dr. Marc Agronin provides the answer. From the description of Alzheimer’s disease by psychiatrist Alois Alzheimer to the current methods of diagnosis and treatment, clinicians have much to learn about and much to contribute to the assessment and management of both patients with this group of illnesses and their daily caregivers. In a direct, readable fashion, Dr. Agronin nicely addresses many of the questions raised by patients, caregivers, and clinicians. He does not oversimplify things, and he does acknowledge that, at times, physicians cannot be as specific as they would like to be. This practical guide is just what the title suggests—useful, succinct, and accessible to the busy practitioner. Peter V. Rabins, MD, MPH Professor, Department of Psychiatry Johns Hopkins School of Medicine, Baltimore, Maryland Downloaded by [New York University] at 02:09 15 August 2016 This page intentionally left blank Downloaded by [New York University] at 02:09 15 August 2016 Acknowledgments First, I thank Anna Moore for giving me the opportunity to revise this book in a third edition, as well as for her guidance, enthusiasm, and confidence; I also thank the staff members at Routledge who have been involved in producing and promoting this book. My wife, Robin, provided the warmest environment imaginable in which to write and revise this book, as well as the love, support, and time to do so. My sons Jacob, Max, and Sam have always provided necessary distractions from my labors; my sincere hope is that one day they will pick up a copy of their father’s book on dementia and react quizzically to all the time and effort I spent writing about a disease that has been eradicated in their lifetimes. I also acknowledge the support of my parents, Ronald and Belle Agronin; my siblings, Robin and Greg Druckman and Michael and Ellen Agronin; and my in-laws, Fred and Marlene Lippman. I owe special thanks to Dr. Alan Cherkasky, whose practice of medicine has always inspired me and whose practical approach has always challenged me to translate even the most complicated approaches into practical benefits for the patient. Many colleagues at the Miami Jewish Health Systems (MJHS) have provided advice and have served as models of care for the book, including Dr. Mairelys Martinez, Niurka Colina, Dr. Amina Rivero, Jose Macias, Alex Gomez, Dr. Barbara Sparacino, and Dr. Brian Kiedrowski. I also acknowledge the inspiration of so many caregivers with whom I have worked, particularly the members of our caregiver support group, who embody the exemplary wisdom and dedication that is key to successful aging and coping. The most important inspiration for this book comes from memories of spending time seeing patients with my grandfather Dr. Simon Cherkasky, who practiced medicine in the small town of Kaukauna, Wisconsin, for over 50 years. He taught me many of the invaluable lessons that pervade this book—to work up each and every patient thor- Downloaded by [New York University] at 02:09 15 August 2016 oughly, to treat them completely, and to make medical decisions based on clinical need rather than on the availability of resources. This wisdom is crucial to the treatment of dementia. My grandmother Eva Cherkasky, his lifelong companion, provided from the warmth of her heart and her kitchen the true chicken soup for my soul. I hope that this book in a small way continues the educational and intellectual legacy of her own grandfather and my great-great grandfather, the beloved and well-respected teacher Rabbi Pesach Iser Gielczynski. This page intentionally left blank Downloaded by [New York University] at 02:09 15 August 2016 Introduction to the Third Edition Do not cast me off in old age; when my strength fails, do not forsake me. —Psalms 71:9 The diagnosis of dementia or even the possibility of such a diagnosis is often greeted with fear and trepidation by those affected. The ensuing fears of losing one’s mind and capa- bilities and of being abandoned or “put away” in an institution are contemplated as fates worse than death. The disease stealthily encroaches in some individuals, robbing them of insight into their illness before they can truly appreciate what has happened. Others notice the changes building month to month and year to year but resign themselves to the process. Still others fight the changes or those around them who insist that they cut back on the activities that once meant independence and integrity but now carry the risk of disaster.

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